Strategies to reduce blood product utilization in obstetric practice

Curr Opin Anaesthesiol. 2017 Jun;30(3):294-299. doi: 10.1097/ACO.0000000000000463.

Abstract

Purpose of review: Patient blood management (PBM) aims to improve patient outcome and safety by reducing the number of unnecessary RBC transfusions and vitalizing patient-specific anemia reserves. Although PBM is increasingly recognized as best clinical practice in elective surgery, implementation of PBM is restrained in the setting of obstetrics. This review summarizes recent findings to reduce blood product utilization in obstetric practice.

Recent findings: PBM-related evidence-based benefits should be urgently adopted in the field of obstetric medicine. Intravenous iron can be considered a safe, effective strategy to replenish iron stores and to correct both pregnancy-related and hemorrhage-related iron deficiency anemia. In addition to surgical techniques and the use of uterotonics, recent findings support early administration of tranexamic acid, fibrinogen and a coagulation factor concentrate-based, viscoelastically guided practice in case of peripartum hemorrhage to manage coagulopathy. In patients with cesarean section, autologous red cell blood salvage may reduce blood product utilization, although its use in this setting is controversial.

Summary: Implementation of PBM in obstetric practice offers large potential to reduce blood loss and transfusion requirements of allogeneic blood products, even though large clinical trials are lacking in this specific field. Intravenous iron supplementation may be suggested to increase peripartum hemoglobin levels. Additionally, tranexamic acid and point-of-care-guided supplementation of coagulation factors are potent methods to reduce unnecessary blood loss and blood transfusions in obstetrics.

Publication types

  • Review

MeSH terms

  • Anemia / diagnosis*
  • Anemia / therapy
  • Anesthesia, Obstetrical / adverse effects
  • Anesthesia, Obstetrical / methods
  • Blood Coagulation Disorders, Inherited / diagnosis*
  • Blood Coagulation Disorders, Inherited / therapy
  • Blood Coagulation Factors / therapeutic use
  • Blood Component Transfusion / statistics & numerical data*
  • Blood Loss, Surgical / prevention & control
  • Cesarean Section / adverse effects
  • Evidence-Based Medicine / methods*
  • Evidence-Based Medicine / trends
  • Female
  • Hemostatics / therapeutic use
  • Humans
  • Incidence
  • Operative Blood Salvage / methods
  • Operative Blood Salvage / trends
  • Oxytocics / therapeutic use
  • Point-of-Care Systems
  • Postpartum Hemorrhage / epidemiology
  • Postpartum Hemorrhage / therapy
  • Pregnancy
  • Pregnancy Complications, Hematologic / diagnosis*
  • Pregnancy Complications, Hematologic / therapy

Substances

  • Blood Coagulation Factors
  • Hemostatics
  • Oxytocics